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complex nature of health systems(including health care systems) posted a new challenge for the system development at all levels. PAC addresses the challenge using the perspective of complex adaptive system and participatory action for change.
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ParticipatoryAction
for
Change
ParticipatoryAction
for
Change
Dim
inis
hing
retu
rn
performance
time
Paradigm shift
No
actio
n ta
lk
only
Incr
emen
tal
chan
ge
Dis
rupti
ve
chan
ge
ศ.นพ. ไพบู�ลย์ สุ�ริ ย์ะวงศไพศาล
ความรั�บผิดชอบแต่�ละบ�คคลโดยล�าพั�ง
เปล��ยนสิ่�งแวดล�อมPuska 2001
COMMUNITYLOCALITY
Agriculture/Gardens/
Local markets
Health Care
PublicSafety
PublicTransport
Manufactured/Imported
Food
Sanitation
Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipatis V. IOTF website 1999: http://www.iotf.org
POPULATION
%
OBESE
AND
OVER--WEIGHT
WORK/SCHOOL/HOME
SchoolFood &Activity
Infections
Labour
Worksite Food & Activity
LeisureActivity/Facilities
Family &Home
INDIVIDUAL
EnergyExpenditure
Food intake :
Nutrient density
Societal policies and processes influencing the population prevalence of obesity
NATIONAL/ REGIONAL
Education
Food & Nutrition
Urbanization
Health
Social security
Transport
Media &Culture
Nationalperspective
INTERNATIONALFACTORS
Development
Globalizationof
markets
Media programs
& advertising
6
7
8
9
17% GDP …5/30 yr gained
NHSO 2014;Kishore S in IOM 2013
the causes of the causes
ParticipatoryAction
for
Change
Passive or active agents
“One child one book one pen can change the world”
04/13/2023 16
โลกสุมมติ
จริ งเท็�จ
เชื่��อว�าจริ ง
ย์�ดม!�นว�าจริ ง
ปกป#องความเชื่��อน!%น
โลกจริ ง
ปริากฎการิณ์ติาม
กฎธริริมชื่าติ อ!นซั!บูซั*อน
สิ่�มผิ�สิ่ทั้� ง5
ParticipatoryAction
for
Change
1.4000 medical and
surgical procedures,
2.6000 drugs
3. 40% of coronary heart disease patients receive
incomplete care, and 60% of pneumonia
patients.
4. Two million people walk into hospital and get
infection they didn’t have because someone
forgot to wash their hands.Atul Gawande at TED2012 19
80,000 catheter-related bloodstream infections
28,000 deaths
$2.3 billion annually
1.8 to 5.2 per 1000 catheter-days
178 actions per days
http://www.newyorker.com/magazine/2007/12/10/the-checklist20
(1)wash their hands with soap,
(2)clean the patient’s skin with chlorhexidine
antiseptic,
(3) put sterile drapes over the entire patient,
(4) wear a sterile mask, hat, gown, and
gloves,
(5) put a sterile dressing over the catheter
site once the line is in.
21
22
23
26
27
Korn Buri DM care system
73,000 inhabitants ; 19,100 households10,000 elderly; 15% disabled
Nurse case/system
manager
Well motivated patients through
group learning led to individuals’ invention fitting their contexts
ParticipatoryAction
for
Change